| NPI | 1003267006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2019-01777) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211750) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2019-07-12 |