| NPI | 1306926126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD473284) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 208628) |
| 208000000X Pediatrics (Licence: NY 208628) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2021-07-14 |