| NPI | 1275652273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.133192) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 146763) |
| 207Q00000X Family Medicine (Licence: PA MD450866) | |
| 208M00000X Hospitalist (Licence: PA MD450866) | |
| 207Q00000X Family Medicine (Licence: NY 243034) | |
| 207Q00000X Family Medicine (Licence: WV WV-SE-1774) | |
| 208M00000X Hospitalist (Licence: WV WV-SE-1774) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2024-03-01 |