| NPI | 1649363821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME86556) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 86556) |
| 207P00000X Emergency Medicine (Licence: FL ME86556) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-11-04 |