| NPI | 1609073204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.126167) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: OH 35.125167) |
| 208M00000X Hospitalist (Licence: WV 23491) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2021-07-22 |