| NPI | 1902047434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 49605) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17734) |
| 174400000X Specialist (Licence: PR 17734) | |
| 207R00000X Internal Medicine (Licence: AZ 49605) | |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2015-10-06 |