| NPI | 1205845633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME0096494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME96494) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2017-06-08 |