| NPI | 1609828110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME124964) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 33705) |
| 207Q00000X Family Medicine (Licence: GA 061646) | |
| 208M00000X Hospitalist (Licence: KY 33705) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2015-08-31 |