| NPI | 1285123752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 312365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT214886) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2021-08-10 |