| NPI | 1730601105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2025039969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2025039969) |
| 207R00000X Internal Medicine (Licence: HI MDR-8320) | |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2025-10-07 |