| NPI | 1922565027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME152937) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME152937) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 14770-I) | |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2023-02-26 |