| NPI | 1679683452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2020009667) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A6189) |
| 207R00000X Internal Medicine (Licence: MO 2020009667) | |
| 207R00000X Internal Medicine (Licence: IL 036151838) | |
| 208M00000X Hospitalist (Licence: IL 036151838) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-04-22 |