| NPI | 1801419551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD480212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 321716) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2023-06-21 |