| NPI | 1780641134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME 90636) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 90636) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2008-12-19 |