| NPI | 1255695607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD455762) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 304301) |
| Enumeration Date | 2012-06-30 |
| Last Update Date | 2023-02-20 |