| NPI | 1376167411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0102207664) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102207664) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2023-06-26 |