| NPI | 1083066179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD467855) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME138812) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-03-12 |