| NPI | 1063552396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME74853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0074853) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-12-14 |