| NPI | 1770996050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 59823) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 59823) |
| 207Q00000X Family Medicine (Licence: IA MD-46257) | |
| 207Q00000X Family Medicine (Licence: MS 926-L) | |
| 208M00000X Hospitalist (Licence: IL 036-144834) | |
| 208M00000X Hospitalist (Licence: IA MD-46257) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2022-12-14 |