| NPI | 1760045462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 93561) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 4704) |
| 207R00000X Internal Medicine (Licence: MI 5151013421) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2025-12-15 |