| NPI | 1740920354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MA 1025930) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NY 341398) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-06-19 |