| NPI | 1821293903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0116019444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116019444) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2021-03-18 |