| NPI | 1063754596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207713) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: LA 207713) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2026-05-01 |