| NPI | 1508279795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 334333) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WI 67694) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2023-05-16 |