| NPI | 1851533525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME112551) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL LL31712) |
| 207P00000X Emergency Medicine (Licence: FL ME112551) | |
| 207P00000X Emergency Medicine (Licence: SC LL31712) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2024-06-10 |