| NPI | 1558500447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD441043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101248471) |
| 207Q00000X Family Medicine (Licence: FL ME130642) | |
| 207Q00000X Family Medicine (Licence: WV 23703) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME130642) | |
| 208D00000X General Practice (Licence: WV 23703) | |
| 208M00000X Hospitalist (Licence: VA 0101248471) | |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2024-10-10 |