| NPI | 1922399930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2015-00885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 258868) |
| 207Q00000X Family Medicine (Licence: NC 201500885) | |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2021-06-14 |