| NPI | 1104103100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME111286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME111286) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2017-06-28 |