| NPI | 1679828578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IA 04734) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R9584) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2021-04-06 |