| NPI | 1083024558 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101283829) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U4400) |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA 306669) | |
| 208M00000X Hospitalist (Licence: FL ME171138) | |
| 207R00000X Internal Medicine (Licence: MS 25221) | |
| 207R00000X Internal Medicine (Licence: LA 306669) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2024-12-03 |