| NPI | 1508897786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420013437) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 050012345) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME EC131111) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2016-08-18 |