| NPI | 1215912829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME78717) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 12402) |
| 207R00000X Internal Medicine (Licence: FL ME78717) | |
| 207R00000X Internal Medicine (Licence: PR 12402) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2024-08-14 |