| NPI | 1508177254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101257515) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101257515) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2015-01-20 |