| NPI | 1265845986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01078995A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 69222-20) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125065115) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2018-04-24 |