| NPI | 1952667974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 35.126661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U9769) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2024-04-08 |