| NPI | 1982191557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 95747) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME157779) |
| 208D00000X General Practice (Licence: FL ME157779) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2026-04-02 |