| NPI | 1790930899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4470) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NE COPS245) |
| 208M00000X Hospitalist (Licence: IA DO-06874) | |
| 208M00000X Hospitalist (Licence: ND 21973) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2025-03-05 |