| NPI | 1326470139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: FL OS16668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB09780600) |
| 207Q00000X Family Medicine (Licence: OH 012197) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2020-05-13 |