| NPI | 1124061056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2001006204) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MO 2001006204) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-07-26 |