| NPI | 1598058497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT199488) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2024-01630) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2024-09-20 |