| NPI | 1720154172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME39762) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME 39762) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2015-09-25 |