| NPI | 1255334959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME88393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME88393) |
| 207Q00000X Family Medicine (Licence: AL MD.37626) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2026-06-15 |