| NPI | 1770144842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 65964) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 65964) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351044133) | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-08-01 |