| NPI | 1306193263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WV 26410) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 26410) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2015-07-24 |