| NPI | 1164912341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022025500) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MO 2022025500) |
| 208M00000X Hospitalist (Licence: IL 036.160496) | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2025-09-25 |