| NPI | 1770550543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101052587) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MT MED-PHYS-LIC-59745) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2021-01-25 |