| NPI | 1598115404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS020088) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116029641) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2019-08-14 |