| NPI | 1417135369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA OS024291) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009898) |
| 207Q00000X Family Medicine (Licence: PA OS024291) | |
| 208600000X Surgery (Licence: PA OT021661) | |
| Enumeration Date | 2008-02-02 |
| Last Update Date | 2026-06-08 |