| NPI | 1881971885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME130303) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 29075) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 28732) | |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2016-11-04 |