| NPI | 1306156856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IL 036128332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.055624) |
| 282N00000X General Acute Care Hospital (Licence: IL 125.055624) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2019-11-14 |