| NPI | 1396162749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01082307A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: GA 82220) | |
| 207Q00000X Family Medicine (Licence: IN 01082307A) | |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2024-06-20 |