| NPI | 1861687162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME100150) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: FL ME100150) |
| 207P00000X Emergency Medicine (Licence: FL ME100150) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2012-10-24 |