| NPI | 1417336603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ME DO2837) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME TP15057) |
| 207P00000X Emergency Medicine (Licence: ME DO2837) | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2019-08-01 |