| NPI | 1023469681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA 320671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MMD.39911LL) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2021-07-02 |