| NPI | 1720347214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY 03823) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 03823) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 03823) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2023-12-04 |