| NPI | 1790772622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 12301) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: AZ 12301) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2017-03-28 |