| NPI | 1992369730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME155225) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME155225) |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2024-10-15 |