| NPI | 1245219971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME86080) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301406664) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2011-09-07 |