| NPI | 1306133921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA MD469697) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 15690) |
| 282NC0060X General Acute Care Hospital, Critical Access (Licence: MO 2014022150) | |
| Enumeration Date | 2011-07-03 |
| Last Update Date | 2020-12-30 |