| NPI | 1295268258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IA DO-55579) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16380) |
| 207Q00000X Family Medicine (Licence: MI 5101026558) | |
| 208M00000X Hospitalist (Licence: LA 350444) | |
| 208M00000X Hospitalist (Licence: MS 36672) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2026-06-25 |