| NPI | 1255957775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME170472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301509165) |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2024-12-06 |