| NPI | 1790206936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA MD470500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272245) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2020-06-17 |