| NPI | 1649384439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 61124) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 61124) |
| 207P00000X Emergency Medicine (Licence: NC 2006-01954) | |
| 207Q00000X Family Medicine (Licence: NC 2006-01954) | |
| 208M00000X Hospitalist (Licence: NC 2006-01954) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2026-03-16 |