| NPI | 1023189818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 264293) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD429491) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2023-05-24 |