| NPI | 1336172519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 158938-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD421891) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2007-07-08 |