| NPI | 1669615308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25M09692300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 257207) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2017-05-05 |