| NPI | 1972168946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-01790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB11236000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2024-01-30 |