| NPI | 1962933911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021014489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R4332) |
| 208M00000X Hospitalist (Licence: KY 54114) | |
| 208M00000X Hospitalist (Licence: KY TP092) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2021-08-12 |