| 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 |