| NPI | 1578782355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2008018693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008018693) |
| 207Q00000X Family Medicine (Licence: KS 6302) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-10-07 |