| NPI | 1992157960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS020454) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 297168) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2025-03-06 |