| NPI | 1558801795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 19585) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: PR 19585) |
| 208M00000X Hospitalist (Licence: PR 19585) | |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2017-03-07 |