| NPI | 1922488147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME132890) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101276433) |
| 207Q00000X Family Medicine (Licence: FL 21804) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2024-02-28 |