| NPI | 1689208274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1231) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ NJDCATEMP-012231) |
| 208D00000X General Practice (Licence: PR 21618) | |
| 208D00000X General Practice (Licence: MA 475) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 13873-I) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 14128-I) | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2022-08-12 |