| NPI | 1225012883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 236955) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD039174E) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2019-02-17 |