| NPI | 1659991040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME158212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME158212) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-26 |
| Last Update Date | 2022-08-25 |