NPI | 1861645525 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 174400000X Specialist (Licence: FL ME 117835) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN10743) |
Enumeration Date | 2008-10-28 |
Last Update Date | 2013-10-24 |