| NPI | 1629208053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OR MD182565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6143 TEP) |
| 207Q00000X Family Medicine (Licence: MO 2012020878) | |
| 207Q00000X Family Medicine (Licence: OR MD182565) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2019-07-29 |