| NPI | 1770920969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NY 207815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 5384) |
| 207Q00000X Family Medicine (Licence: NY 307815) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2022-09-28 |