| NPI | 1821227570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: KY 45299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 45299) |
| 207Q00000X Family Medicine (Licence: SC LL31968) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2022-02-01 |