| NPI | 1194701771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME161320) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD065824L) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2023-05-26 |