| NPI | 1417487703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS020671) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101023377) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2026-02-03 |