| NPI | 1609071661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101255626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25751) |
| 207Q00000X Family Medicine (Licence: VA 0101255626) | |
| 207Q00000X Family Medicine (Licence: WA MD61245176) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2023-03-24 |