| NPI | 1700515640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101287138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.253236) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2025-11-06 |