| NPI | 1710271697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 59752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 9527A) |
| 207Q00000X Family Medicine (Licence: GA 80985) | |
| 208M00000X Hospitalist (Licence: GA 80985) | |
| 208M00000X Hospitalist (Licence: WY 9527A) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2021-02-26 |