| NPI | 1003012204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10525) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: ID M-10525) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2022-05-11 |