| NPI | 1033302575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: SC 34253) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD0000042870) |
| 207Q00000X Family Medicine (Licence: TN 42870) | |
| 207Q00000X Family Medicine (Licence: NY 245657) | |
| 207Q00000X Family Medicine (Licence: SC 34253) | |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2021-05-26 |