| NPI | 1073558409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD452747) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 234676) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2021-03-01 |