| NPI | 1801180575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 4192) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 4192) |
| 207Q00000X Family Medicine (Licence: KY 03605) | |
| 208M00000X Hospitalist (Licence: KY 03605) | |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2021-07-21 |