| NPI | 1619979853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME92207) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME92207) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2020-10-02 |