| NPI | 1043709850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL TRN28190) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 21755) |
| 208600000X Surgery (Licence: HI 7500) | |
| 208M00000X Hospitalist (Licence: WI 21755) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2023-05-18 |