| NPI | 1003885815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME81763) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 217452) |
| 207P00000X Emergency Medicine (Licence: FL ME81763) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2019-03-01 |