| NPI | 1245235852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0036715) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD040234L) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2023-03-07 |