| NPI | 1306222856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 24183) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208283) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2023-08-11 |