| NPI | 1669705091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-146420) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 27163) |
| 207Q00000X Family Medicine (Licence: WV 27163) | |
| 208M00000X Hospitalist (Licence: OH 35-146420) | |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2022-10-19 |