| NPI | 1184202806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME176188) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A185144) |
| 208D00000X General Practice (Licence: CA A185144) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208D00000X General Practice (Licence: FL ME176188) | |
| 208M00000X Hospitalist (Licence: CA A185144) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME176188) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-02-24 |