| NPI | 1336458322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE 344878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD453391) |
| 207R00000X Internal Medicine (Licence: NY SSN/ITIN deleted) | |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2022-01-28 |