| NPI | 1891059507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX T3230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T3230) |
| 207Q00000X Family Medicine (Licence: IL 125061947) | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2023-08-07 |