| NPI | 1689898611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 43505) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA15058) |
| 207R00000X Internal Medicine (Licence: AZ 43505) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2010-08-09 |