| NPI | 1871166009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MT 132421) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57251511) |
| Enumeration Date | 2021-07-24 |
| Last Update Date | 2024-05-21 |