| NPI | 1114565041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2025009664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 336477) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: TN 73898) | |
| 207R00000X Internal Medicine (Licence: IL 036164991) | |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2026-06-29 |