| NPI | 1053670133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 078379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 078379) |
| 207Q00000X Family Medicine (Licence: TN 51074) | |
| 207V00000X Obstetrics & Gynecology (Licence: GA 078379) | |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2018-12-21 |