| NPI | 1912198144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 252422) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS013931) |
| 207R00000X Internal Medicine (Licence: NJ 25MB08372100) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2025-03-19 |