| NPI | 1962865931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CA A156934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2025-0356) |
| 207Q00000X Family Medicine (Licence: CA A156934) | |
| 208M00000X Hospitalist (Licence: TX U6738) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2025-05-21 |