| NPI | 1184035909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL ME151301) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL ME151301) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2023-12-20 |