| NPI | 1770990798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01582) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 2014-01582) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2024-08-08 |