| NPI | 1215963343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 9501625) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 9501625) |
| 207Q00000X Family Medicine (Licence: SC 19528) | |
| 207Q00000X Family Medicine (Licence: NC 9501625) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2024-03-13 |