| NPI | 1760582779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME84360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 42931020) |
| 207Q00000X Family Medicine (Licence: FL ME84360) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-03-13 |