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 |