| NPI | 1497067474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD450043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC MD32626) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2026-08-10 |