| NPI | 1902254915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2023013959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2023013959) |
| 208000000X Pediatrics (Licence: MO 2023013959) | |
| 208M00000X Hospitalist (Licence: MO 2023013959) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2024-04-25 |