| NPI | 1700316262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA 342415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.071088) |
| 207Q00000X Family Medicine (Licence: AZ 67725) | |
| 207Q00000X Family Medicine (Licence: TN 66288) | |
| 207Q00000X Family Medicine (Licence: TX S7515) | |
| 208M00000X Hospitalist (Licence: TX S7515) | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2024-06-27 |