| NPI | 1053979674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A22402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 315634) |
| 207Q00000X Family Medicine (Licence: NJ 25MB11240400) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2024-05-10 |