| NPI | 1679701023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 323657) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 323657) |
| 208M00000X Hospitalist (Licence: WV 28966) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2020-08-03 |