| NPI | 1063864346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME170596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 62653) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2024-10-07 |