| NPI | 1104388511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 65770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 65770) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2026-07-13 |