| NPI | 1235515313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD468943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT209585) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2021-06-28 |