| NPI | 1508412024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL84145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1015036) |
| 208D00000X General Practice (Licence: SC 84145) | |
| 208M00000X Hospitalist (Licence: MA 1015036) | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2025-03-10 |