| NPI | 1235792680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01088843A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT217197) |
| 207R00000X Internal Medicine (Licence: WA 61250614) | |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2025-05-20 |