| NPI | 1699769356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2004019500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2004019500) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2019-04-08 |