| NPI | 1104185990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101258229) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101258229) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2021-03-23 |