| NPI | 1891006631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 76410) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: NC 2013-01624) |
| 207R00000X Internal Medicine (Licence: GA 76410) | |
| Enumeration Date | 2010-06-26 |
| Last Update Date | 2021-02-04 |