| NPI | 1528551058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD27596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT215733) |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2024-07-31 |