| NPI | 1083093942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NY 305762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 4918) |
| 207Q00000X Family Medicine (Licence: NY 305762) | |
| 208M00000X Hospitalist (Licence: WI 4918) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2025-02-13 |