| NPI | 1275947939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016081) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2025-10-03 |