| NPI | 1407235955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME136218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME136218) |
| 207Q00000X Family Medicine (Licence: IN 11018468A) | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2024-11-18 |