| NPI | 1467455345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME79271) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME0079271) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2024-06-01 |