| NPI | 1669122123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 35.153619) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 32584) |
| 207R00000X Internal Medicine (Licence: MN 74756) | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-09-04 |