| NPI | 1730135138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: KY 1000633) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 35026) |
| 207R00000X Internal Medicine (Licence: KY 35026) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: KY 35026) | |
| 208M00000X Hospitalist (Licence: KY 35026) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2022-09-20 |