| NPI | 1154613677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: ID 1571552) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60522010) |
| 207RS0010X Internal Medicine Sports Medicine (Licence: WA MD60522010) | |
| 208M00000X Hospitalist (Licence: NV MD60522010) | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2025-08-07 |