| NPI | 1114458130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY TP229) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY TP229) |
| 208M00000X Hospitalist (Licence: KY TP229) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2021-08-02 |