| NPI | 1790985810 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2020-04362)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 49826020)  | 
| 208M00000X Hospitalist (Licence: WI 49826)  | |
| Enumeration Date | 2007-07-18 | 
| Last Update Date | 2021-04-07 |