| NPI | 1649651100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2018023745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015015422) |
| 207Q00000X Family Medicine (Licence: MO 2018023745) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2019-08-23 |