| NPI | 1003259870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CA A125091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A125091) |
| 207R00000X Internal Medicine (Licence: VA 0101253439) | |
| 208D00000X General Practice (Licence: CA A125091) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2020-05-29 |