| NPI | 1770069718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01088629A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 309901) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 32710) | |
| 207Q00000X Family Medicine (Licence: IN 01088629A) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2025-09-13 |