| NPI | 1184987398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME 126884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.126771) |
| 207Q00000X Family Medicine (Licence: MI 5315073808) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2016-04-06 |