| NPI | 1245442789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 56607) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD437570) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2024-01-29 |