| NPI | 1619141231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME104905) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 2945R) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2014-09-10 |