| NPI | 1912405507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AL 41544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 85429) |
| 208M00000X Hospitalist (Licence: GA 85429) | |
| 207P00000X Emergency Medicine (Licence: GA 85429) | |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2020-10-07 |