| NPI | 1235927344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 25204) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: PR 25204) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2026-08-10 |