| NPI | 1366605313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101259921) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WA MD60216868) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2024-08-29 |