| NPI | 1366162703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2025012043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2025012043) |
| 207R00000X Internal Medicine (Licence: OH 57.253048) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2025-04-11 |