| NPI | 1023040656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD14613) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: ME MD14613) |
| 208M00000X Hospitalist (Licence: ME MD14613) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-04-09 |