| NPI | 1578209482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: ID 3471540) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-2172) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: UT 14216362-1205) | |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2026-08-31 |