| NPI | 1891100038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2018029429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018029429) |
| 207Q00000X Family Medicine (Licence: CT 56828) | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2022-07-21 |