| NPI | 1902039530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME115723) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 24939) |
| 207R00000X Internal Medicine (Licence: FL ME115723) | |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2021-05-11 |