| NPI | 1083811285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 37266) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 50246-020) |
| 207Q00000X Family Medicine (Licence: AZ 37266) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2015-09-24 |