| NPI | 1376577825 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017029652) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-115521) | 
| 208M00000X Hospitalist (Licence: IL 036-115521) | |
| Enumeration Date | 2006-07-10 | 
| Last Update Date | 2023-05-23 |