| NPI | 1134785603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY 05174) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.031128) |
| 207R00000X Internal Medicine (Licence: KY 05174) | |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2022-07-05 |