| NPI | 1487617585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME36501) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME36501) |
| 208200000X Plastic Surgery (Licence: FL ME36501) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2020-08-04 |