| NPI | 1255592481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2011-01249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 52035) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2017-03-15 |