| NPI | 1306841044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME108164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME108164) |
| 207Q00000X Family Medicine (Licence: OH 35075829) | |
| Enumeration Date | 2005-06-18 |
| Last Update Date | 2018-07-18 |