| NPI | 1467727719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME125004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME125004) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2021-05-26 |