| NPI | 1053639187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 118780) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ME118780) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 10-120) | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2023-07-12 |