| NPI | 1790045144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101257892) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101257892) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101257892) | |
| Enumeration Date | 2012-05-19 |
| Last Update Date | 2026-03-04 |