| NPI | 1225494156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD455162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101263264) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2024-04-27 |