| NPI | 1750745477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TN 59716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 59716) |
| 207Q00000X Family Medicine (Licence: VA 0101266941) | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2024-06-25 |