| NPI | 1780065599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C192999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 27400) |
| 208M00000X Hospitalist (Licence: LA 343236) | |
| 208M00000X Hospitalist (Licence: AR E-11610) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2025-06-10 |