| NPI | 1841253705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME83375) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME83375) |
| 207P00000X Emergency Medicine (Licence: AL 25447) | |
| 207Q00000X Family Medicine (Licence: AL 25447) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2021-11-16 |