| NPI | 1154629640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 73031) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.011211) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2015-08-10 |