| NPI | 1225357684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: PA MT200657) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 244566) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2024-07-01 |