| NPI | 1346687852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL OS16800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16800) |
| 207Q00000X Family Medicine (Licence: GA 077015) | |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2020-05-26 |