| NPI | 1215069059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME127276) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ME127276) |
| 225100000X Physical Therapist (Licence: FL PT21264) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2018-03-17 |