| NPI | 1659057354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2026034951) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 9725) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2026-08-13 |