| NPI | 1679868046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101263880) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: VA 0101263880) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2021-07-14 |