| NPI | 1811376411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134419) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 076987) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 21875) | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2022-10-18 |