| NPI | 1316908593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD421579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101234850) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2023-11-29 |