| NPI | 1518616986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME165666) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2024-01-30 |