| NPI | 1770587347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME31870) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME31870) |
| 208D00000X General Practice (Licence: FL ME31870) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2010-12-15 |