| NPI | 1912972597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD053496L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 224303-1) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-03-11 |