| NPI | 1609397413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NV 20058) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 24828) |
| 207R00000X Internal Medicine (Licence: NV 20058) | |
| 207R00000X Internal Medicine (Licence: FL 142113) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2020-08-27 |