| NPI | 1710502182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NH 33449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD27102) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME TP20071) | |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2024-07-12 |