| NPI | 1104104348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME130599) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME130599) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2020-07-07 |