| NPI | 1700414109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 324392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220087) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2026-05-08 |