| NPI | 1972956639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2019027864) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019027864) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2019-08-28 |