| NPI | 1053427690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME59935) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME59935) |
| 208D00000X General Practice (Licence: GA 057804) | |
| 208D00000X General Practice (Licence: FL ME59935) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-04-01 |