| NPI | 1366707580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 055047) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CT 55047) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2019-08-30 |