| NPI | 1891363032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 328846) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT223537) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2024-06-14 |