| NPI | 1700269362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NY 289501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 289501) |
| 207Q00000X Family Medicine (Licence: ME LT18015) | |
| 207R00000X Internal Medicine (Licence: CT 62056) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2023-08-18 |