| NPI | 1164817003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY C3624) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35132284) |
| 207R00000X Internal Medicine (Licence: KY C3624) | |
| 208M00000X Hospitalist (Licence: OH 35132284) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2025-08-20 |