| NPI | 1760829337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 286012) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2016-08-15 |