| NPI | 1083225890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY P105265) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2022-02-03 |