| NPI | 1649295403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107960) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD33903) |
| 207P00000X Emergency Medicine (Licence: FL ME107960) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-05-23 |