| NPI | 1164527115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME122661) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 199393) |
| 207P00000X Emergency Medicine (Licence: FL ME122661) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2024-05-15 |