| NPI | 1265880520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 295215) |
| 208D00000X General Practice (Licence: AL DO.1791) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2022-09-14 |