| NPI | 1962694802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OR MD28542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD28542) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: OR MD28542) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2017-10-05 |