| NPI | 1588157945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD474789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT214983) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2021-09-14 |