| NPI | 1962076034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY 59236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0100021) |
| 208M00000X Hospitalist (Licence: PA MD491898C) | |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2026-01-14 |