| NPI | 1730169863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME101043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME101043) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2026-04-27 |