| NPI | 1780657734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME71393) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: GA 73624) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2020-10-15 |