| NPI | 1649563560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME120373) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME120373) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2014-09-04 |