| NPI | 1033535216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 11143A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WY 11143A) |
| 207Q00000X Family Medicine (Licence: WY 11143A) | |
| 208M00000X Hospitalist (Licence: WY 11143A) | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: WY 11143A) | |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2022-06-17 |