| NPI | 1518490721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD210969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD468993) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2022-08-16 |