| NPI | 1962630392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101276436) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD60386035) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2023-07-10 |