| NPI | 1902003635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME100581) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME100581) |
| 207R00000X Internal Medicine (Licence: FL ME100581) | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2024-04-02 |