| NPI | 1417301995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD476349) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT210476) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2023-03-14 |