| NPI | 1578098075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME146956) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2083P0500X Preventive Medicine Preventive Medicine/Occupational Environmental Medicine (Licence: FL ME146956) | |
| Enumeration Date | 2017-04-22 |
| Last Update Date | 2024-01-24 |