| NPI | 1013619980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME176351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 345534) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2026-08-06 |