| NPI | 1306101159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 278711) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 278711) |
| 207R00000X Internal Medicine (Licence: PA 0T014870) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2023-06-29 |