| NPI | 1396249116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY P107523) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2021-04-09 |