| NPI | 1750801148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA OS019903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018089) |
| 207Q00000X Family Medicine (Licence: PA OS019903) | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2020-12-15 |