| NPI | 1770821621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 82459) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 82459) |
| 208M00000X Hospitalist (Licence: GA 82459) | |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2025-07-25 |