| NPI | 1578591384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME54335) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-059942) |
| 207Q00000X Family Medicine (Licence: FL ME54335) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-03-24 |