| NPI | 1255620019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 51279) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125060059) |
| 207R00000X Internal Medicine (Licence: TX Q0343) | |
| 207R00000X Internal Medicine (Licence: AZ 51279) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2016-03-09 |