| NPI | 1871883850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME115880) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: FL ME115880) |
| 208D00000X General Practice (Licence: FL ME115880) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN17983) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2023-02-04 |