| NPI | 1720181282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C150323) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 13840) |
| 208000000X Pediatrics (Licence: PR 13840) | |
| 208M00000X Hospitalist (Licence: PR 13840) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2022-02-11 |