| NPI | 1376923946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD466112) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208754) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2020-12-17 |