| NPI | 1265110563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MT MED-PHYS-LIC-171562) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 9799) |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2026-07-02 |