| NPI | 1174598999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 245012) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD061252L) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2019-03-12 |