| NPI | 1356366884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME96405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME96405) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME96405) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2024-03-15 |