| NPI | 1790210698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11023814A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 36044) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2024-06-13 |