| NPI | 1912346321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 10225A) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WY 10225A) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2016-11-09 |