| NPI | 1093132367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME160725) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 56209) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2026-05-07 |