| NPI | 1205464567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME170075) |
| 208M00000X Hospitalist (Licence: FL ME170075) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-06-03 |