| NPI | 1699115402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 109630) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 283895) |
| 208M00000X Hospitalist (Licence: AZ 283895) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2025-11-10 |