| NPI | 1003134651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AL 32385) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 32385) |
| 208000000X Pediatrics (Licence: OR MD169966) | |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2021-09-01 |