| NPI | 1104263060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 076394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301102801) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2024-01-09 |