| NPI | 1760845846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 76412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD199814) |
| 208M00000X Hospitalist (Licence: CA A159750) | |
| 208D00000X General Practice (Licence: CA A159750) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2026-02-05 |