| NPI | 1699778423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 33185) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 33185) |
| 207P00000X Emergency Medicine (Licence: KY 33185) | |
| 207R00000X Internal Medicine (Licence: KY 33185) | |
| 208M00000X Hospitalist (Licence: KY 33185) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2021-12-21 |