| NPI | 1417993064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2001010524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2001010524) |
| 207R00000X Internal Medicine (Licence: KS 04-29712) | |
| 208000000X Pediatrics (Licence: MO 2001010524) | |
| 208000000X Pediatrics (Licence: KS 04-29712) | |
| 208M00000X Hospitalist (Licence: KS 429712) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2016-12-21 |