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 |