| NPI | 1366554222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2008-01353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 35966) |
| 207R00000X Internal Medicine (Licence: NC 2008-01353) | |
| 208M00000X Hospitalist (Licence: NC 2008-01353) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-07-15 |