| NPI | 1265827158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME131288) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2019-01-29 |