| NPI | 1619326683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME133657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME133657) |
| 207P00000X Emergency Medicine (Licence: GA 83982) | |
| 208D00000X General Practice (Licence: GA 83982) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-09-30 |