| NPI | 1942884770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX V8307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V8307) |
| 207Q00000X Family Medicine (Licence: OK 38353) | |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2025-10-24 |