| NPI | 1194831636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 42090) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TN 42090) |
| 207R00000X Internal Medicine (Licence: CO 42866) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2014-05-08 |