| NPI | 1760758700 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME126615) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| 207R00000X Internal Medicine (Licence: FL ME126615) | |
| Enumeration Date | 2012-03-23 | 
| Last Update Date | 2022-07-27 |