| NPI | 1023135894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME135150) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2017-01022) |
| 208D00000X General Practice (Licence: VA 0101244033) | |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2024-02-09 |