| NPI | 1720203854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME100694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME100694) |
| 207Q00000X Family Medicine (Licence: GA 063486) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2014-08-05 |