| NPI | 1609280247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 301616) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT207416) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2020-08-24 |