| NPI | 1487821641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME109645) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ME109645) |
| 207Q00000X Family Medicine (Licence: LA PGY1 training permit) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME109645) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2026-03-30 |