| NPI | 1700310463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 29626401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os15679) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2025-07-31 |