| NPI | 1740693688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME133292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10049151) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2022-07-21 |