| NPI | 1255950440 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 322416) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS024395) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-02-04 |