| NPI | 1063901593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL OS16465) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16465) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2023-03-31 |