| NPI | 1306310644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT217168) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 313748) |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2021-12-13 |