| NPI | 1205109675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2019012552) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WI 64465) |
| 207R00000X Internal Medicine (Licence: WI 64465-21) | |
| 207R00000X Internal Medicine (Licence: MO 2019012552) | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2019-07-17 |