| NPI | 1336589019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD473011) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 265679) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2025-10-01 |