| NPI | 1659377141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME112246) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 21450) |
| 207P00000X Emergency Medicine (Licence: FL ME112246) | |
| 207Q00000X Family Medicine (Licence: SC 21450) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2023-03-15 |