| NPI | 1710411459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME142488) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 83769) |
| 207P00000X Emergency Medicine (Licence: FL TRN25055) | |
| 207P00000X Emergency Medicine (Licence: CA 164790) | |
| 2083C0008X Preventive Medicine, Clinical Informatics Specialist (Licence: CA 164790) | |
| 208D00000X General Practice (Licence: GA 83769) | |
| 208D00000X General Practice (Licence: CA 164790) | |
| 208D00000X General Practice (Licence: FL ME142488) | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2022-02-01 |