| NPI | 1780828988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME112150) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN13500) |
| 207Q00000X Family Medicine (Licence: FL ME112150) | |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2018-10-23 |