| NPI | 1902157779 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 89436) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS13617) | 
| 208M00000X Hospitalist (Licence: FL OS13617) | |
| Enumeration Date | 2012-09-19 | 
| Last Update Date | 2024-01-14 |