| NPI | 1215375423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL OS14771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS14771) |
| 207R00000X Internal Medicine (Licence: WV ED0468A) | |
| 208D00000X General Practice (Licence: FL UO3663) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2022-02-25 |