| NPI | 1891791786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 6637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02001759A) |
| 208M00000X Hospitalist (Licence: IA DO-03591) | |
| 207Q00000X Family Medicine (Licence: HI DOS-873) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2025-08-18 |