| NPI | 1861411084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101244369) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IA 37837) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2025-12-02 |