| NPI | 1538219589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME48878) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 25091) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2019-10-23 |