| NPI | 1427095967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME163641) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 204119) |
| 207Q00000X Family Medicine (Licence: FL ME163641) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2025-03-07 |