| NPI | 1124009501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NM 80-44) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM 80-44) |
| 207P00000X Emergency Medicine (Licence: FL ME107006) | |
| 207P00000X Emergency Medicine (Licence: LA MD203548) | |
| 207Q00000X Family Medicine (Licence: NM 80-44) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2022-04-11 |