| NPI | 1518279520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AL 32715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 32715) |
| 207Q00000X Family Medicine (Licence: MS 22660) | |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2019-08-29 |