| NPI | 1093007452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MT 57841) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD461443) |
| 208000000X Pediatrics (Licence: LA 302381) | |
| 208M00000X Hospitalist (Licence: LA 302381) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2023-05-19 |