| NPI | 1386958189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09174700) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2022-05-25 |