| NPI | 1013536267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2025052742) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036.162211) |
| 207Q00000X Family Medicine (Licence: KY TP636) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-02-11 |