| NPI | 1770920613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T8575) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: VA 0101269978) |
| Enumeration Date | 2013-06-02 |
| Last Update Date | 2025-11-11 |