| NPI | 1114603248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS025899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT022930) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2026-04-28 |