| NPI | 1962488577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA MD443959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.071001) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2025-10-01 |