| NPI | 1972828903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 32827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL AL32826) |
| 207Q00000X Family Medicine (Licence: TN 54452) | |
| 208M00000X Hospitalist (Licence: TN 54452) | |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2016-07-19 |