| NPI | 1184853459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 45215) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: SC 36538) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2017-06-30 |