| NPI | 1710216866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MD C04112) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C04112) |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2018-01-11 |