| NPI | 1316394158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD467751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211271) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2019-06-27 |