| NPI | 1053846295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD472091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 338847-01) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2026-01-20 |