| NPI | 1639583321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY C0606) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY C0606) |
| 207Q00000X Family Medicine (Licence: CO DR.0063299) | |
| 207Q00000X Family Medicine (Licence: WI 74871) | |
| 207Q00000X Family Medicine (Licence: NE 30167) | |
| 208M00000X Hospitalist (Licence: CO DR.0063299) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2023-10-23 |