| NPI | 1477083798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R-10824) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 325791) |
| 207R00000X Internal Medicine (Licence: TX S9045) | |
| 208M00000X Hospitalist (Licence: TX S9045) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2023-12-14 |