| NPI | 1700445608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX V2707) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-1715) |
| 207Q00000X Family Medicine (Licence: VA 0102208164) | |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2024-11-04 |