| NPI | 1689081812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60719749) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WI 1562) |
| 207R00000X Internal Medicine (Licence: ID 5171362) | |
| 207R00000X Internal Medicine (Licence: FL ME172610) | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2026-04-30 |