| NPI | 1063049708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS023580) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ na) | |
| 207Q00000X Family Medicine (Licence: NJ 25MB11896800) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2024-07-01 |