| NPI | 1548946080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT229067) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD494754) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2026-06-17 |