| NPI | 1538781091 |
|---|---|
| Former Name | CAROLINE ELIZABETH CALLAHAN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 262927) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 319731) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2022-11-28 |