| NPI | 1215160262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME111789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME111789) |
| 207Q00000X Family Medicine (Licence: IL 036.128927) | |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2021-03-29 |