| NPI | 1760808711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL OS20943) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: PA OS018579) |
| 207Q00000X Family Medicine (Licence: PA OS018579) | |
| 207Q00000X Family Medicine (Licence: FL OS20943) | |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2024-11-13 |