| NPI | 1285796987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD446603) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 241942-1) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2018-03-29 |