| NPI | 1013312669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA OS019411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016772) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2024-10-09 |