| NPI | 1801317680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WV 3749) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3749) |
| 207Q00000X Family Medicine (Licence: WV 354399) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2021-11-02 |