| NPI | 1902118623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TN 50153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 50153) |
| 208D00000X General Practice (Licence: KY 46324) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2023-07-27 |