| NPI | 1386384857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME176403) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN41273) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-08-25 |