| NPI | 1881746527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 043631) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME43631) |
| 207P00000X Emergency Medicine (Licence: GA 31606) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2016-07-27 |