| NPI | 1114934650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101054215) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME144634) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 305644) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2023-08-21 |