| NPI | 1992026561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: WA OP61156104) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX P4846) |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2025-04-28 |