| NPI | 1922590652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME DO3111) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME TP18025) | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2023-08-15 |