| NPI | 1790206845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY TP156) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.029263) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2022-07-21 |