| NPI | 1679832661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 52856) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TN 52856) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2019-05-07 |