| NPI | 1811250897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CT 054051) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PA MT-202680) |
| 207R00000X Internal Medicine (Licence: CT 054051) | |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2015-12-11 |