| NPI | 1225568256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD491004C) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 13381) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2025-08-29 |