| NPI | 1356638068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AK 130860) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: AK 130860) |
| 208D00000X General Practice (Licence: HI 1530) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2018-04-11 |