| NPI | 1487051314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME140709) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME140709) |
| 207P00000X Emergency Medicine (Licence: WV 28415) | |
| 208600000X Surgery (Licence: MI L570803) | |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2024-02-27 |