| NPI | 1417164518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA A99956) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A99956) |
| 282N00000X General Acute Care Hospital (Licence: CA A99956) | |
| 208M00000X Hospitalist (Licence: CA A99956) | |
| 208D00000X General Practice (Licence: CA A99956) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2015-10-19 |