| NPI | 1629332150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME156816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME156816) |
| 207Q00000X Family Medicine (Licence: OH 35140512) | |
| 207Q00000X Family Medicine (Licence: IL 125061952) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2023-01-11 |