| NPI | 1912401647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME172554) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MS 29096) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-06-30 |