| NPI | 1780677625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO R4G91) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R4G91) |
| 207R00000X Internal Medicine (Licence: KS 04-26564) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2019-09-05 |