| NPI | 1851915342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02007168A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T8905) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10071689) | |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2023-08-08 |