| NPI | 1902591092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 72050) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 72050) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2026-07-06 |