| NPI | 1497381479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX W2474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX W2474) |
| 208D00000X General Practice (Licence: FL ME158604) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2026-03-12 |