| NPI | 1386808798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023009763) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT191259) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2023-07-19 |