| NPI | 1548765043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 292683) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: MA 292683) | |
| 208000000X Pediatrics (Licence: ME MD25991) | |
| 207R00000X Internal Medicine (Licence: ME MD25991) | |
| 208M00000X Hospitalist (Licence: ME MD25991) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2026-07-08 |