| NPI | 1285927277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY 46367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 46367) |
| 207Q00000X Family Medicine (Licence: FL ME123545) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2019-06-06 |