| NPI | 1891917597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 53617) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WI 53617) |
| 207Q00000X Family Medicine (Licence: OR MD175978) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2016-03-10 |