| NPI | 1679563753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ME 015710) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD15710) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2019-01-31 |