| NPI | 1831689793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI MD-20713) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI MD-20713) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2022-06-27 |