| NPI | 1396937900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME102298) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301086297) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL ME102298) | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2019-07-19 |