| NPI | 1083056113 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD15257)  | 
| Additional Taxonomies | 208M00000X Hospitalist (Licence: RI MD15257)  | 
| 207R00000X Internal Medicine (Licence: MI 4301103287)  | |
| Enumeration Date | 2013-07-17 | 
| Last Update Date | 2016-08-17 |