| NPI | 1871150136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2022025517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0451425) |
| 208M00000X Hospitalist (Licence: KS 0451425) | |
| 207R00000X Internal Medicine (Licence: MO 2022025517) | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2025-10-08 |