| NPI | 1669167847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA 352621) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 36897) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-07-31 |