| NPI | 1952791097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PR 21363) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 21363) |
| 208D00000X General Practice (Licence: PR 21363) | |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2021-03-23 |