| NPI | 1891314449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME162251) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA A196205) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2026-04-22 |