| NPI | 1649461625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 44465) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: WV 22835) | |
| 208M00000X Hospitalist (Licence: KY 44465) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2017-04-07 |