| NPI | 1174145353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 325526) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1019991) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2024-09-19 |