| NPI | 1710317979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IN 01082603A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY tp487) |
| 208M00000X Hospitalist (Licence: KY 46606) | |
| 207Q00000X Family Medicine (Licence: CO TL0006314) | |
| Enumeration Date | 2013-11-25 |
| Last Update Date | 2023-01-27 |