| NPI | 1790071074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2015025828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-38326) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NE 6449) | |
| 208M00000X Hospitalist (Licence: MO 2015025828) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2022-09-16 |