| NPI | 1891480059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 06269) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02008361A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-02-23 |