| NPI | 1770014763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-02071) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 85596) |
| 208M00000X Hospitalist (Licence: SC 85596) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2022-11-29 |