| NPI | 1992172860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64450-20) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: WI 64450-20) |
| 208M00000X Hospitalist (Licence: WI 64450-20) | |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2026-04-29 |