| NPI | 1568743680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 275841) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199590) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2014-07-10 |