| NPI | 1134140775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME0067443) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME0067443) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2012-03-08 |