NPI | 1609452341 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME163579) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
208D00000X General Practice (Licence: FL ME163579) | |
Enumeration Date | 2021-03-23 |
Last Update Date | 2024-03-11 |