| NPI | 1568090330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD486148) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0096555) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2024-08-09 |