| NPI | 1376779454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CA A117627) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A117627) |
| 207R00000X Internal Medicine (Licence: CA A117627) | |
| 207Q00000X Family Medicine (Licence: CA A117627) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2025-09-15 |