| NPI | 1619968013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 37781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01062436A) |
| 208M00000X Hospitalist (Licence: KY 37781) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2020-12-08 |