| NPI | 1922623446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101288234) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX U4225) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2026-04-03 |