| NPI | 1053660969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 079675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 079675) |
| 207R00000X Internal Medicine (Licence: MS 22687) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2019-10-31 |