| NPI | 1700306164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME363883) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 363883) |
| 208D00000X General Practice (Licence: PR 19895) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 19895) | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-08-31 |