| NPI | 1902060312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD434425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 246342) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2014-01-14 |