| NPI | 1255794871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 66230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 31446) |
| 207Q00000X Family Medicine (Licence: OH 35.138734) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2023-05-10 |