| NPI | 1962760546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TN 2739) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 2739) |
| 207Q00000X Family Medicine (Licence: VA 0102204177) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2015-11-23 |