| NPI | 1235767666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME159231) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 5237R) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME159231) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-10-05 |