| NPI | 1316409659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME165740) |
| 208D00000X General Practice (Licence: NY 326606) | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2024-01-18 |