| NPI | 1225581234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS019816) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 550614866) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2019-11-13 |