| NPI | 1174031686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ACN1214) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME172442) |
| 207P00000X Emergency Medicine (Licence: PR 19833) | |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2025-09-15 |