| NPI | 1801582184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IA MD-56874) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA MD-56874) |
| 208000000X Pediatrics (Licence: WI 100121-851) | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2026-07-16 |