| NPI | 1851903181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY P106561) |
| 208D00000X General Practice (Licence: NY P106561) | |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2022-04-18 |