| NPI | 1437491123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 25560) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-3270) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS T-3270) | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2018-07-25 |