| NPI | 1801412044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 100032) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA11555200) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2024-12-20 |