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 |