| NPI | 1639127996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS10915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 2057) |
| 208M00000X Hospitalist (Licence: FL OS10915) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2026-05-07 |