| NPI | 1538714456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT019671) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS19039) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2024-04-04 |