| NPI | 1659733616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY 52442) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 61111) |
| 208000000X Pediatrics (Licence: KY R4154) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2024-11-20 |