| NPI | 1194010652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA 301976) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL 33624) |
| 208000000X Pediatrics (Licence: SC LL 33624) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2020-12-31 |