| NPI | 1831624014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-14205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME144848) |
| 208D00000X General Practice (Licence: FL ME144848) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2022-12-08 |