| NPI | 1861838518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 290028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A134451) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2021-11-29 |