| NPI | 1841533932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 13093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 55070) |
| 207Q00000X Family Medicine (Licence: VA 0101260431) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2023-06-28 |