| NPI | 1962645671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME135081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME135081) |
| 207R00000X Internal Medicine (Licence: GA 70100) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2024-01-31 |