| NPI | 1114587672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT219134) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 57188) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2023-05-09 |