| NPI | 1033798541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2024029058) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MO 2024029058) |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2025-08-18 |