| NPI | 1881075851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 66591) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018286A) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MN 66591) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11018286A) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2019-12-31 |