| NPI | 1588920193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: FL ME122760) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: OK 31104) |
| 208M00000X Hospitalist (Licence: OK 31104) | |
| 207R00000X Internal Medicine (Licence: FL ME122760) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2026-09-04 |