| NPI | 1730574963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018023747) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IA MD-44454) |
| 208M00000X Hospitalist (Licence: MO 2018023747) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2024-02-16 |