| NPI | 1710477500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-15687) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11390481-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-04-24 |