| NPI | 1932317112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 250164-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS014824) |
| 207R00000X Internal Medicine (Licence: NM A-1494-09) | |
| 207R00000X Internal Medicine (Licence: HI 1256) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2022-04-11 |