| NPI | 1194827659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME48596) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 48596) |
| 207P00000X Emergency Medicine (Licence: FL ME48596) | |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2014-10-23 |