| NPI | 1972563898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD449953) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 192233) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2018-04-12 |