| NPI | 1912428673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 61308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP8113) |
| 207Q00000X Family Medicine (Licence: AZ 61308) | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2023-03-20 |