| NPI | 1679868855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: HI MD-20221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL33585) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2019-10-30 |