| NPI | 1104937390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME0074158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME74158) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME74158) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-11-23 |