| NPI | 1942615562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 69939) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2017-02208) |
| 208M00000X Hospitalist (Licence: MS 24772) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2023-08-22 |