| NPI | 1831571611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL 150587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-114916) |
| 208M00000X Hospitalist (Licence: NC 2018-01700) | |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2023-03-16 |