| NPI | 1104200112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IA MD-44938) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P31980) |
| 207R00000X Internal Medicine (Licence: IA 44938) | |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2018-07-24 |