| NPI | 1902254154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME142851) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R75745) |
| 207R00000X Internal Medicine (Licence: FL ME142851) | |
| Enumeration Date | 2016-05-28 |
| Last Update Date | 2021-05-26 |