| NPI | 1114546884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD482819) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 65924) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2023-09-20 |