| NPI | 1508966573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101033148) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: VA 0101033148) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-02-21 |