| NPI | 1073894788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA MD454977) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0010089) |
| 207R00000X Internal Medicine (Licence: PA MD454977) | |
| 282N00000X General Acute Care Hospital (Licence: DE C1-0010089) | |
| 314000000X Skilled Nursing Facility (Licence: DE C1-0010089) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2022-04-22 |