| NPI | 1407161003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 12824) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: ND 12824) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2019-03-12 |