| NPI | 1558591891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME114426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA mt196193) |
| 207R00000X Internal Medicine (Licence: OH 57.017460) | |
| 207R00000X Internal Medicine (Licence: FL ME114426) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2016-04-18 |