| NPI | 1184365694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101288881) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: VA 0101288881) |
| 207Q00000X Family Medicine (Licence: VA 0101288881) | |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2026-07-23 |