| NPI | 1265824999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME141919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 36284) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2019-08-27 |