| NPI | 1235300211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME100401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME100401) |
| 207Q00000X Family Medicine (Licence: AL L2726R) | |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2018-11-15 |