| NPI | 1568727220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 79664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125060842) |
| 208M00000X Hospitalist (Licence: GA 79664) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2024-02-06 |