| NPI | 1811939614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME147037) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 13845) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2025-05-27 |