| NPI | 1821664251 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35C.001852) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MI 4301512381) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2025-02-10 |