| NPI | 1740854405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 32759) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME167838) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-05-12 |