| NPI | 1508286451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 52575) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 04558) |
| 208M00000X Hospitalist (Licence: MT 52575) | |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2020-04-28 |