| NPI | 1457701708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD468004) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267445) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2019-10-16 |