| NPI | 1902148133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 9148024-1205) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: UT 9148024-1205) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2024-04-24 |