| NPI | 1871552356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME 92910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 92910) |
| 208M00000X Hospitalist (Licence: NY 236528) | |
| 207Q00000X Family Medicine (Licence: NY 236538) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2015-07-10 |