| NPI | 1568520971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME137501) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH4968) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-01-04 |