| NPI | 1588124234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME165737) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363A00000X Physician Assistant (Licence: PR 039-P.A.) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-08-08 |