| NPI | 1366175531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: SC 94189) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-4665) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2025-07-24 |