| NPI | 1083625313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA MD.06674R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.06674R) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2013-09-18 |