| NPI | 1962407627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 171659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD040599L) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2026-01-09 |