| NPI | 1851655203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME133141) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2012021976) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN19206) | |
| Enumeration Date | 2012-06-30 |
| Last Update Date | 2021-08-31 |