| NPI | 1023050549 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OR MD210106)  | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD210106)  | 
| 208M00000X Hospitalist (Licence: KY 37413)  | |
| 208M00000X Hospitalist (Licence: NM MD2013-0305)  | |
| 207Q00000X Family Medicine (Licence: KY 37413)  | |
| 208M00000X Hospitalist (Licence: AK 218703)  | |
| Enumeration Date | 2006-06-11 | 
| Last Update Date | 2024-05-08 |