| NPI | 1669091138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME169897) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN30571) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2025-11-19 |