| NPI | 1013571736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036.168255) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME165552) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2024-01-12 |