| NPI | 1891054540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO2836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 70982) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2024-02-09 |