| NPI | 1972769313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2014031376) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-37599) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2019-05-24 |