| NPI | 1376003392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2022-02703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101273210) |
| 207Q00000X Family Medicine (Licence: NC 2022-02703) | |
| 207Q00000X Family Medicine (Licence: TN 61968) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-02-20 |