| NPI | 1700520269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MI 5101028163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101028163) |
| 208D00000X General Practice (Licence: MI 5101028163) | |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2025-07-22 |