| NPI | 1104313311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD474620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216820) |
| 207Q00000X Family Medicine (Licence: NY 312900) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2022-05-13 |