| NPI | 1760893531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME137055) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 36134) |
| 207P00000X Emergency Medicine (Licence: AL 36134) | |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2020-05-05 |