| NPI | 1104063536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 69349) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WI 69349) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2021-10-19 |