| NPI | 1710929757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME118919) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 39387) |
| 208000000X Pediatrics (Licence: MN 39387) | |
| 207R00000X Internal Medicine (Licence: MN 39387) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2024-05-28 |