| NPI | 1992017719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301096242) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301096242) |
| 207P00000X Emergency Medicine (Licence: KY 47522) | |
| 207P00000X Emergency Medicine (Licence: IN 01082826A) | |
| 207Q00000X Family Medicine (Licence: KY 47522) | |
| 208M00000X Hospitalist (Licence: MI 4031096242) | |
| 208M00000X Hospitalist (Licence: KY 47522) | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2021-07-12 |