| NPI | 1184260283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME178095) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ACN1221) |
| 208D00000X General Practice (Licence: FL ACN1221) | |
| 208D00000X General Practice (Licence: PR 21603) | |
| Enumeration Date | 2019-11-23 |
| Last Update Date | 2026-06-05 |