| NPI | 1871025551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CA 19084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 19084) |
| 207R00000X Internal Medicine (Licence: CA 19084) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2021-11-02 |