| NPI | 1962612630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 69126) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ME106548) |
| 207Q00000X Family Medicine (Licence: AL L2663) | |
| 207R00000X Internal Medicine (Licence: PA MT190229) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2025-10-01 |