| NPI | 1083025860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS021797) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 2889) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2022-06-14 |