| NPI | 1629259403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TN 44251) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA mt186999) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2016-06-23 |