| NPI | 1396109880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 20190090407) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036175509) |
| 207Q00000X Family Medicine (Licence: MO 2019009047) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2025-09-04 |