| NPI | 1699265280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3480) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 3480) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2025-07-01 |