| NPI | 1104160357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60634910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS12024) |
| 207R00000X Internal Medicine (Licence: VA 0102205058) | |
| 208M00000X Hospitalist (Licence: MN 74315) | |
| Enumeration Date | 2012-11-11 |
| Last Update Date | 2025-04-17 |