| NPI | 1396007316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 10266619-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02004307A) |
| 207Q00000X Family Medicine (Licence: UT 10266619-1204) | |
| 207Q00000X Family Medicine (Licence: IN 02004307A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2019-11-21 |