| NPI | 1235629692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 110118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 66673) |
| 207Q00000X Family Medicine (Licence: OH 57.249928) | |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2026-04-27 |