| NPI | 1558458463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: SC 36919) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NC 866573) |
| 207R00000X Internal Medicine (Licence: NC 200500108) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-07-14 |