| NPI | 1174781066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME115818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH FV0823155) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2018-12-11 |