| NPI | 1164005849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT222571) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD485082) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2024-08-29 |