| NPI | 1104249507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 13746) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: ND 13746) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2023-06-06 |