| NPI | 1457738619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02005829A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018906) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021825) | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2021-03-11 |