| NPI | 1104849132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101268989) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: VA 0101268989) |
| 207Q00000X Family Medicine (Licence: NC 200401409) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-07-17 |