| NPI | 1174105738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: NY 329463) |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2025-05-14 |