| NPI | 1760046940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME150226) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 1760046940) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2022-06-15 |