| NPI | 1316563380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 73619) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220758) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2025-01-07 |