| NPI | 1235574369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD23181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2016-00887) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2021-02-17 |