| NPI | 1962865931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A156934) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CA 156934) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-02-16 |