| NPI | 1710618897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02007414A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11022204A) |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2023-12-28 |