| NPI | 1346808235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-02243) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD25739) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2023-08-24 |