| NPI | 1497717920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD449524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116015375) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2021-03-08 |