| NPI | 1790066108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021569) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: NJ 25MB09405100) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2023-11-27 |