| NPI | 1700049897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME103478) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME103478) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019150) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2017-06-12 |