| NPI | 1679580591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME86070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 29727) |
| 207R00000X Internal Medicine (Licence: FL ME 86070) | |
| 207P00000X Emergency Medicine (Licence: NC 29727) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2014-10-08 |