| NPI | 1528402377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY 04131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 04131) |
| 208000000X Pediatrics (Licence: KY 04131) | |
| 208000000X Pediatrics (Licence: IN 02005042) | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2018-08-20 |