| NPI | 1710324116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 57425) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2015-01522) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-27 |
| Last Update Date | 2019-06-07 |