| NPI | 1770812802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: SC MD81806) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD81806) |
| 207Q00000X Family Medicine (Licence: NC 2015-01838) | |
| Enumeration Date | 2009-12-20 |
| Last Update Date | 2023-11-28 |