| NPI | 1104494236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5315226786) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MI 5315226786) |
| 208D00000X General Practice (Licence: MI 5151015294) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2026-04-22 |