| NPI | 1457597163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35091509) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 251030) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2025-12-01 |