| NPI | 1891890257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME48769) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME48769) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME48769) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2016-06-15 |