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 |