| NPI | 1912430562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 90511) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 59792) |
| 207R00000X Internal Medicine (Licence: GA 90511) | |
| 208M00000X Hospitalist (Licence: AZ 59792) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2021-12-29 |