| NPI | 1689936213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR T2016-100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E9948) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AR 919019519) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2025-05-05 |