| NPI | 1578940664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MA 1023499) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME135933) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2025-07-18 |