| NPI | 1063678498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME105279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 321225) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2021-04-26 |