| NPI | 1174605620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2019009758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 28008) |
| 208000000X Pediatrics (Licence: SC 28008) | |
| 208M00000X Hospitalist (Licence: SC 28008) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2021-03-31 |