| NPI | 1144955055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2025028055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 39458) |
| Enumeration Date | 2022-07-24 |
| Last Update Date | 2025-09-17 |