| NPI | 1700873189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 10739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 10739) |
| 208M00000X Hospitalist (Licence: NM MD2012-0158) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2015-05-26 |