| NPI | 1346279981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-00904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD423559) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2023-01-03 |