| NPI | 1811040942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 051925) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 36849) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2017-01-30 |