| NPI | 1710541206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 62051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.083226) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 171000000X Military Health Care Provider (Licence: TN 62051) | |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-05-15 |