| NPI | 1578724308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD445750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 204756) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2023-08-09 |