| NPI | 1083004709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME133205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10054747) |
| 208D00000X General Practice (Licence: GA 73256) | |
| 208D00000X General Practice (Licence: PR 18988) | |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2023-03-15 |