| NPI | 1891189965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME132971) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME132971) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2023-02-27 |