| NPI | 1922590827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT216000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 334783) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2026-01-22 |