| NPI | 1124257407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CA C149729) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: LA MD.204015) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: GA 002494) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2018-06-18 |