| NPI | 1811019631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME100158) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME 100158) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CT 048944) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NY 257621) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2022-01-30 |