| NPI | 1548261357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 111-320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 58593) |
| 207Q00000X Family Medicine (Licence: VA 0101253895) | |
| 207Q00000X Family Medicine (Licence: WY 5242A) | |
| 207Q00000X Family Medicine (Licence: ID M9101) | |
| 207Q00000X Family Medicine (Licence: OR MD25187) | |
| 208M00000X Hospitalist (Licence: VA 0101253895) | |
| 208M00000X Hospitalist (Licence: MN 58593) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2022-08-19 |