| NPI | 1649644311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15971) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: KY 04358) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2023-05-15 |