| NPI | 1689240269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD485166) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 12647) |
| 208D00000X General Practice (Licence: GA 12647) | |
| 208M00000X Hospitalist (Licence: PA MD485166) | |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2024-08-29 |