| NPI | 1750021580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME175796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME175796) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-08-13 |