| NPI | 1487764676 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MI 4301101997)  | 
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036-055852)  | 
| 207R00000X Internal Medicine (Licence: IN 01059499A)  | |
| Enumeration Date | 2006-08-30 | 
| Last Update Date | 2012-11-20 |