| NPI | 1265885313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018999) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT017199) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2020-12-12 |