| NPI | 1760535694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125578) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: KS 04-32035) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2016-11-03 |