| NPI | 1831689504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA11101600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA11101600) |
| 207Q00000X Family Medicine (Licence: OH 35.141464) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2022-11-11 |