| NPI | 1003171372 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A139738) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A139738) | 
| 208M00000X Hospitalist (Licence: CA A139738) | |
| Enumeration Date | 2012-07-11 | 
| Last Update Date | 2024-07-03 |