| NPI | 1194160028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2016011320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016011320) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2022-05-13 |