| NPI | 1043519598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2015014693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015014693) |
| 207R00000X Internal Medicine (Licence: KS 0438039) | |
| 208000000X Pediatrics (Licence: KS 0438039) | |
| 208000000X Pediatrics (Licence: MO 2015014693) | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2021-03-25 |