| NPI | 1972664829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 164125) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 164125) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NY 164125) | |
| 207R00000X Internal Medicine (Licence: PA MD041171E) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2011-02-02 |