| NPI | 1457871865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD23378) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT212873) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2020-07-31 |