| NPI | 1417199605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NY 263286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 42773) |
| 207Q00000X Family Medicine (Licence: NY 263286) | |
| 207Q00000X Family Medicine (Licence: KY TP480) | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2022-07-21 |