| NPI | 1548794795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME150095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME150095) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2022-08-23 |