| NPI | 1114008067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CA A32473) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: CA A32473) |
| 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: CA A32473) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2022-11-02 |