| NPI | 1588655625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OK 30474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME86566) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2017-05-10 |