| NPI | 1457361180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME95073) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME0095073) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-03-13 |