| NPI | 1194726596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: ND PT19748) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VT 0550030660) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-06-13 |