| NPI | 1124076377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL OS10002) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS1002) |
| 207Q00000X Family Medicine (Licence: OH 34008620) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-07-21 |