| NPI | 1003334368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD196981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT212992) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2021-02-15 |