| NPI | 1114282464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 55603) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6745) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2022-07-25 |