| NPI | 1689234106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT219044) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 322523) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2023-07-18 |