| NPI | 1861781544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102204157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11016270A) |
| 207R00000X Internal Medicine (Licence: IN 11016270A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2026-03-24 |