| NPI | 1245590231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB11790400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 279433) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2023-06-12 |