| NPI | 1215233002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2013-01976) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 44187) |
| 207R00000X Internal Medicine (Licence: KY TP545) | |
| 207R00000X Internal Medicine (Licence: VA 0101248849) | |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2022-05-16 |