| NPI | 1518344548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A160222) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 298115) |
| 208D00000X General Practice (Licence: FL ME129130) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2023-12-28 |