| NPI | 1619469772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 102983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018390) |
| 207R00000X Internal Medicine (Licence: PA OS020415) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2026-08-07 |