| NPI | 1093249625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA PS020536) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT017579) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2022-09-13 |