| NPI | 1114918174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0046483) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD033554E) |
| 207P00000X Emergency Medicine (Licence: FL ME46483) | |
| 207Q00000X Family Medicine (Licence: PA MD033554E) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2021-09-22 |