| NPI | 1952664963 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 73613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL1587) |
| 207R00000X Internal Medicine (Licence: GA 73613) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2021-01-18 |