| NPI | 1558361428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME92652) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME0092652) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2017-03-22 |