| NPI | 1790084366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA MD461907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD461907) |
| 207Q00000X Family Medicine (Licence: VA 0101261081) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2024-09-13 |