| NPI | 1720262207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME104797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 001308) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2013-02-12 |