| NPI | 1528761046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: NY 207QA0505X) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2024-06-25 |