| NPI | 1194066027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CO DR.0063362) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102203895) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2020-07-21 |