| NPI | 1912228792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME119144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME119144) |
| 208000000X Pediatrics (Licence: FL ME119144) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2018-03-17 |