| NPI | 1003038274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 189578A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD039838E) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-12-08 |