| NPI | 1821352345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 59908) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125062221) |
| 207R00000X Internal Medicine (Licence: AZ 59908) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2020-07-29 |