| NPI | 1952339855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME78247) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TN 54011) |
| 207P00000X Emergency Medicine (Licence: TN 54011) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-11-23 |