| NPI | 1710261961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KS 04-37609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 28807) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2017-03-08 |