| NPI | 1083829105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME157844) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.118250) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2024-05-10 |