| NPI | 1568154508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MD D0107416) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI 1568154508) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2026-08-04 |