| NPI | 1053607457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OR MD182996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD182996) |
| 207Q00000X Family Medicine (Licence: MI 4301099178) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2023-01-18 |