| NPI | 1427674043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN34064) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MD-GTL-20-00805.) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN34064) | |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2021-10-15 |