| NPI | 1225265176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01969) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT195232) |
| 208M00000X Hospitalist (Licence: NC 2012-01969) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2017-08-07 |