| NPI | 1336244698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME72155) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME72155) |
| 207P00000X Emergency Medicine (Licence: FL ME72155) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2012-07-26 |