| NPI | 1053808873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX T5512) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 312084) |
| 207Q00000X Family Medicine (Licence: NY 312084) | |
| 207Q00000X Family Medicine (Licence: TX T5512) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2026-03-05 |