| NPI | 1144841289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301511081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD478012) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2025-11-14 |