| NPI | 1174910590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023006898) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 324373) |
| 208D00000X General Practice (Licence: FL ME139328) | |
| 208M00000X Hospitalist (Licence: MO 2023006898) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2025-07-10 |