| NPI | 1285365601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.180873) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V7025) |
| 208D00000X General Practice (Licence: TX V7025) | |
| 208M00000X Hospitalist (Licence: TX V7025) | |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2026-07-06 |