| NPI | 1063673960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NY 258018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 258018) |
| 207Q00000X Family Medicine (Licence: KS 04-35678) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2022-02-15 |