| NPI | 1346800729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 316443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT019401) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-03-06 |