| NPI | 1154612372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME114400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME114400) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2022-10-03 |