| NPI | 1023240579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A121630) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 53114) |
| 208M00000X Hospitalist (Licence: CA A121630) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2018-03-22 |