| NPI | 1811281314 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207034)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA GETP.200854)  | 
| 208M00000X Hospitalist (Licence: LA MD.207034)  | |
| Enumeration Date | 2011-06-02 | 
| Last Update Date | 2021-06-16 |