| NPI | 1154946747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD491915) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MT221221) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2025-11-20 |