| NPI | 1619383924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME133593) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME133593) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2023-01-08 |