| NPI | 1619219870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 76334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 76334) |
| 208D00000X General Practice (Licence: GA 76334) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2016-12-06 |