| NPI | 1386023067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 302156) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD465361) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2023-09-18 |