| NPI | 1376986554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA11232800) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2023-01-30 |