| NPI | 1275541799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME96403) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME96403) |
| 207Q00000X Family Medicine (Licence: MO 2014020147) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2025-05-21 |