| NPI | 1801923065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 34.014255) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 04593) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 0000000981) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2020-09-22 |