| NPI | 1801473905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-17726) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: AR E-17726) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-05-23 |