| NPI | 1861997462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 94970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA VA0116031889) |
| 207Q00000X Family Medicine (Licence: VA 0102205766) | |
| 207Q00000X Family Medicine (Licence: NC 2021-01731) | |
| 208M00000X Hospitalist (Licence: NC 2021-01731) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-09-06 |