| NPI | 1962768713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 77587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 52649) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN 52649) | |
| 208M00000X Hospitalist (Licence: GA 77587) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2017-06-07 |