| NPI | 1083102305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3651) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 3651) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2022-09-15 |