| NPI | 1649657594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 274862) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MA 274862) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2026-03-17 |