| NPI | 1265442727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME122910) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G24818) |
| 208D00000X General Practice (Licence: CA G24818) | |
| 208D00000X General Practice (Licence: FL ME122910) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2015-02-23 |