| NPI | 1164151791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 339162) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 339162) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-08-05 |