| NPI | 1912318940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 79694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 317396) |
| 207Q00000X Family Medicine (Licence: KY 49669) | |
| 207Q00000X Family Medicine (Licence: GA 79694) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2023-03-05 |