| NPI | 1093076077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY TP942) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AK 112317) |
| 208000000X Pediatrics (Licence: AK 112317) | |
| 208M00000X Hospitalist (Licence: AK 112317) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2018-09-24 |