| NPI | 1942418991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: FL ME112990) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 239872) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-08-02 |